Efforts are up to push diabetes down

Nutrition programs, group doctor visits, and social worker pep talks are some of the local attempts to stave off a growing threat from the disease in Massachusetts and nationwide

By Kay Lazar | November 8, 2010

If Stephen Lezama were to pick his poison, it would be Cadbury chocolate bars. The 66-year-old used to bring two of them to his overnight police dispatching shift at Wentworth Institute of Technology in Boston — a habit that continued even after he was diagnosed with type 2 diabetes, which generally strikes as people gain weight and become more sedentary with age.

His doctor recommended a twice-monthly nutrition program at the Codman Square Health Center in Dorchester, which helped Lezama, a Trinidad native who loves to cook, jettison the Cadbury bars and also go easier on the mega-meals loaded with rice.

But he started to slide after the program ended, and it wasn’t until he started another more intensive intervention earlier this year — this one sends a social worker to his home once a week — that he got back on the right food track.

Success on the exercise front has been more elusive.

“I am so tired when I get off work, I don’t do it,’’ said Lezama, who hasn’t made a dent on his excess 50 pounds.

Lezama’s struggles, say health specialists, are becoming alarmingly commonplace and illustrate the significant challenges faced in heading off a projected tsunami of diabetes.

A recent federal government report concluded that the number of adults with diabetes could double or triple by the year 2050, if current trends continue. One in 10 has the disease now, but as many as one in three adults could develop diabetes as people live longer and minority populations, which are more at risk for type 2 diabetes, increase, according to the Centers for Disease Control and Prevention.

“The direction we are headed in is unsustainable,’’ said Ann Albright, director of CDC’s Division of Diabetes Translation.

“Let’s hope we don’t have to get to the brink of the cliff,’’ she said, before specialists establish the best plans of attack.

The disease’s toll is already heavy. Diabetics have medical costs that are more than twice those of people without the disease — running up an estimated $174 billion annually, says the CDC.

Diabetics have trouble converting their food into energy because their bodies either lack or are unable to use the hormone insulin, which helps sugar enter cells. If their disease is left uncontrolled, sugar and fats accumulate in the blood and, over time, damage vessels and nerves, often leading to a cascade of other health issues, including kidney failure, vision problems, and poor circulation in the legs and feet, which can lead to amputations.

Type 1 diabetes, which accounts for only about 5 percent of cases, generally strikes in childhood and still puzzles scientists, who believe this form may be linked to an autoimmune disorder and possibly also be genetic. There is no known way to prevent this type of diabetes.

But what is especially frustrating to health specialists is that type 2 diabetes — the remaining 95 percent — is largely preventable. Exercise, weight control, and good nutrition can often ward it off.

Bill Walczak, the center’s executive director, said that not long ago, he asked a group of 120 high school students at the center how many had immediate family members with diabetes. Every single hand went up.

“That was stunning, even to me,’’ Walczak said. “In lower-income communities, there is an expectation that when you get older, your hair gets gray and you get diabetes, because it’s so common.’’

The majority of Codman’s patients are African-American or Latino, with many immigrants from Haiti and the Caribbean. Disease trackers aren’t entirely sure why diabetes strikes hardest in minority communities, but believe the answer is multifaceted, including genetics, higher obesity rates, and poverty, which can affect the availability of quality food, medical care, even the safety of exercise and recreation options in the community.

“If you are trying to live on 20 bucks a week for your family, you will live on macaroni and cheese; that’s a big driver,’’ said Dr. Philip Severin, the center’s medical director.

Over the past five years, Codman caregivers have struck back with a multi-pronged program aimed at changing attitudes, exercise, and nutrition habits. They’ve also changed the traditional doctors’ visits for diabetics.

Instead of the typical 10- or 15-minute session with a physician, diabetics are organized into groups of 10 that meet with caregivers for a three-hour visit, allowing each more time with specialists, but also with a group of kindred spirits.

“In the process, they build social relationships that will be supportive,’’ Walczak said. “We need more support mechanisms for patients, rather than just more drugs.’’

The center launched cooking and fitness classes tailored for diabetics. It opened a gym, with funding from a private partnership, that allows physicians to write free prescriptions for exercise for diabetics and others with chronic diseases. Another partnership pays for prescriptions for diabetics to get free fresh fruits and vegetables at the center’s farmer’s market.

A 2002 study of people with elevated blood sugar levels, known as prediabetics, funded by the National Institutes of Health, found a 58 percent reduction in the risk of developing type 2 diabetes among the participants who lost between 5 and 7 percent of their body weight and got at least 150 minutes weekly of physical activity.

Success at the Codman center is measured in more modest milestones.

In the past two years, there has been an 8 percent increase in the number of adult diabetic patients with their blood sugar levels well-controlled, and a 6 percent increase in those with blood pressure in check. The percentage of diabetics who smoked dropped 7 percent.

Beyond the Codman, state disease trackers found that the percentage of Massachusetts adults diagnosed with diabetes nearly doubled, from 4.1 to 7.4 percent, between 1994 and 2007.

“As we see the obesity prevalence continue to increase, or at least not decrease yet, we have reason to believe the diabetes risk is as high, if not higher, across the state today than in 2007,’’ said Dr. Jewel Mullen, director of the Bureau of Community Health and Prevention in the state’s Department of Public Health.

The state has launched several obesity-fighting campaigns in the past couple of years, with the twin goal of lowering rates of diabetes and related chronic diseases, Mullen said. Among the programs is Mass in Motion, which awards grants to cities and towns for creating bike paths, trails, or even upgrading sidewalks to improve walkability in a neighborhood.

For Lezama, who still has 50 pounds to lose, the issue is not a lack of places to walk — he lives near Franklin Park in Dorchester — it is the willpower. The community social worker the Codman sends to his home every week to help him stay on track has encouraged him to set modest weekly exercise goals. His latest: to walk at least once a week in the morning after his overnight shift.

“My doctor used to be on me. He would say, ‘If you want to live, you need to lose weight,’ ’’ Lezama said.

“But having [the social worker] come every week,’’ Lezama said, “you get more encouragement to do the right things.’’